Consensus on Overcoming Barriers to Long-Acting Injectable Use in Schizophrenia

Leighann Forbes, MD, presented findings from a Delphi panel study examining perspectives of nurse practitioners (NPs) and physician associates (PAs) on initiating long-acting injectable (LAI) treatments in adults with schizophrenia.

Forbes contextualized the public health burden: mental health conditions affect approximately 1 billion people worldwide and are projected to become the leading cause of disability globally by 2030. Schizophrenia affects approximately 2.8 million adults in the United States, yet approximately 40% of those individuals are not receiving adequate care.¹ Forbes emphasized the clinical consequences of inadequately managed schizophrenia, noting that the average patient may experience as many as 9 relapses within 6 years—each episode capable of disrupting stability and contributing to long-term functional decline—and that relapse has been associated with increased all-cause mortality.²

Despite well-documented clinical benefits, fewer than 20% of patients with schizophrenia are currently receiving LAI therapy, a gap that the study sought to address. The Delphi panel consisted of NPs and PAs with substantial LAI experience, convened to generate expert consensus on barriers to LAI initiation and strategies to improve treatment conversations.

The panel yielded several key findings, Forbes said. Panelists recommended introducing LAI options earlier in the treatment journey rather than reserving them as a last resort, and advocated for normalizing LAIs as a standard treatment option. They emphasized centering discussions on individual patient preferences and goals, highlighting the flexibility and reduced daily treatment burden of LAIs relative to oral therapy. The use of clear, accessible language was identified as essential, as was the provision of ongoing educational resources to address patient and caregiver misperceptions.

Finally, panelists underscored the importance of team-based, shared decision-making—noting that NPs and PAs often spend more time discussing therapeutic options with patients than psychiatrists do, making their engagement in the treatment conversation critical.

Forbes concluded that "in schizophrenia, stability is everything," and that improving provider-patient communication around LAI therapy represented a key step toward reducing relapse and improving long-term outcomes.

Dr Forbes is the vice president of US medical affairs for neuroscience at Johnson & Johnson.

References

1. Mental health by the numbers. National Alliance on Mental Illness. Accessed June 9, 2026. https://www.nami.org/mental-health-by-the-numbers/

2. Rivelli A, Fitzpatrick V, Nelson M, et al. Real-world predictors of relapse in patients with schizophrenia and schizoaffective disorder in a large health system. Schizophrenia (Heidelb). 2024;10(1):28.